Joe is a paramedic who’s had enough. He works on an FRU in an area notorious for misuse of the service and unsavoury characters. He has spent the last umpteen years dashing through the streets on blue lights to be greeted with pregnant ladies brandishing their neatly packed suitcases or twenty-year-olds with colds who wanted him to bring them the paracetamol. He’s filled out endless LA52s (‘incident report forms’) after being abused by the local scrotes and That Regular Who Dribbled on Reynolds’ Arm. Joe can’t remember the last time he was sent to someone who was actually seriously ill. I think if you offered Joe a nice little job in a cake shop instead, he’d snap it up – and to be honest, he’d have more chance of using his skills there, should someone overdose on cake and arrest on the shop floor.

Joe likes to phone us on the desk for a good-natured whinge about most of his calls. He knows all our names, and we recognise his voice instantly. Usually he calls after he’s finished with the patient – “You’ll never guess what – she’d had the rash for six years and decided to call 999 now, at 11pm on Saturday night!” – but occasionally he can’t contain himself and calls on the radio whilst speeding to the call.

Saturday was one such occasion.

“Why is this swine flu call a Cat A?” he complained.

“Because the patient is having chest pain…” said the radio op.

“He’s probably got a cough! Why do I have to go… I know, I have to…” sighed Joe. “Okay, thank you.”

Thirty minutes later, my phone rang. On the other end was an extremely animated Joe.

“What happened?” I asked, anticipating another tale of outrageous timewasting.

“This 24-year-old, right, been in bed with swine flu for a week. Looks rough and sweaty, but people generally do with flu. He tells me he’s feeling much worse and that his chest hurts, so I wire him up to the heart monitor – that’s protocol for anyone with chest pain. I read the monitor printout, and he’s only having a heart attack! At that point, the ambulance pulls up, so I shout over to them to get a move on so we can blue light him into the cardiac hospital. We get him on the trolley, and he goes into cardiac arrest right in front of my eyes! I couldn’t believe it!”

“What happened next?” I asked.

“Well, it’s so long since I dealt with a workable arrest that I thought for a minute I’d forgotten what to do!” said Joe. “But it all came back. Two shocks with the defib and we got him back. He was only down for about thirty seconds and he’s partially conscious now. Crew have just blued him in, I followed them to hospital in case he went down again, but he didn’t.”

“You didn’t want to go on that call,” I reminded him. “You thought it was another time waster – admittedly, so did we! Just goes to show, you can never be sure. I bet you won’t complain about the ‘rubbish’ calls we sent you on in future.”

“No!” said Joe. “Never again! I’ve learned my lesson!”

Do you think Joe ever complained about a call again? Yes, of course he did. But he was quiet for at least a week…

Something similar happened to my colleague (on the receiving end) – diagnosed with swine flu, took his Tamiflu, started feeling worse, called up the doctor, who wouldn't see him (because he had swine flu), ended up being blued to hospital to spend 6 hours on an ECG because they thought he was having a heart attack. Turns out it was a chest infection that had got bad (and was probably never swine flu at all – fortunately also not a heart attack!).

There's always going to be the one call that catches you out. It always happens the day you become too complacent…. There's no such thing as seeing it all! But I can fully understand Joe's frustrations…

The "chest pain" is often a red herring, as most people reading this will know. Yes, most times it's just as Joe expected, but there's always the one…

However, when a caller goes to NHS Redirect and they call an ambulance for a cough, that's when it gets silly.

Last December we had a bug doing the rounds. It was a nasty cough and cold. The cough was enough to make people's chest muscles hurt.

I was sent to a DIB where a young woman had been hospitalised for a couple of days with a really bad chest infection. This time, she'd momentarily had a bad cough and panicked – hence the DIB. The crew arrived shortly after me.

The next thing, Control asked me to leave this patient (I'm a CFR) and go to another a couple of streets away – chest pain. I told the crew I was working with that they'd soon be following me (as it was obvious that our patient was going nowhere).

I arrived at the second address, a small terraced house. The couple were in the front room, and he was obviously suffering from the bug. It took me about 30 seconds to decide that his chest pain was most probably non-cardiac in origin, and the patient was of the same opinion.

He'd called NHS Redirect to get some advice about what to take for his cough. One of the first questions he was asked was "Have you any pain in your chest?" He answered honestly that he had, because he'd been coughing so much. The Panic Button was well and truly slapped at that point.

A few minutes after I arrived, an FRV came with a paramedic and an observer. Seconds later the crew I'd been working with before also turned up.

This elderly couple had been invaded by five members of the ambulance service and it was getting a bit congested in their small sitting room.

I stood myself down, to try and make a bit of room for the poor bloke who only wanted to know whether to buy Tixilix or Boot's' own!

Couldn't he have talked to a nurse before all hell was let loose on him, rather than a relatively untrained call-taker with a protocol sheet?

I've talked them down from sending me an ambulance before. They were really insistant and got a nurse to call me back twice that day to see if I wanted one yet, even though I said I'd get my bf to take me up to A&E when he finished work. I'd called at 3 in the afternoon on a Friday (bank holiday as well), as the chest pain that had been keeping me awake despite tramadol and zolpidem for a week, had gotten much worse that day. I knew it couldn't be _that_ bad, as I was shuffling about the house, and it had been going on so long. But they can be pretty insistant. (Few hours in the majors room at A&E that evening, and turned out I had costochondritis to add to my list of things my body does to spite me, lol).

But another time they got an ambulance out for me for a mild allergic reaction. I knew it wasn't bad, but my flatmate made the call as I was all flopped out on the sofa with a peticheal rash and sweats. The embarassment of being pulled out of the back of an ambulance and wheeled into the out of hours Drs… *sigh* I knew I didn't need anyhting other than antihistamines, but NHS Direct go for ambulance on the slightest presentation of 'emergency' symptoms, even if the caller is certain it's not the heart attack/meningitis that it could signal.

Ray, CFRs are highly trained people, not like some local first aid wackos I could mention… They are trained with AEDs, Medical Gases, Heart Monitors and many other items of equipment that NHS ambulances carry
Suzi, "Joe" sounds very familiar to a blogging paramedic that I know works for the LAS as well…

I am one of those first aid wackos as you so thoughtfully put it,i am trained with AEDs,med gases, heart monitors, stethoscopes etc i am also training to be a CFR what makes you think you are any better than me or other members of my team.
I myself have attended some very serious accidents and the care and treatment of the patient was of the same quality that would be given by any ambulance crew.I have also been first on scene to cardiac arrest on a number of occasions all of these persons lived to tell the tale, so please do not knock us when if left to joe public these people would most likely have not survived by the time an ambulance crew arrived. We all do the same job wether or not we drive an ambulance or a CFR vehicle,we are all out there to save lives not to bitch about wether or not EMTs are better than CFRs or First Aiders.

So, Keith was, quote, "First on the scene to cardiac arrest on a number of occasions all of these persons lived to tell the tale". Sorry,mate, ALL of them? Unless the number of occasions you're talking about is less than two I'll have to take that statement with a pinch of salt. Most patients rescucitated successfuly have had efficient C.P.R. carried out within seconds of collapse. Members of "Joe Public" have been responsible for many saved lives, witnessing the initial collapse and administering good C.P.R. Unfortunately this happens all too seldom as do successful rescucitations. Could you let us know at how many of the serious accidents you attended were you able to give the same quality of care as ANY ambulance crew to a patient who needed to be intubated, cannulated, infused with appropriate fluids and administered drugs as necessary? Calm, competent First Aiders do a great job for the community and I was always happy to see one on the scene when I arrived in my R.R.V. I am sure that many of them must have cringed when they read your posted comment. Ambulance staff are not better PEOPLE than First Aiders but ARE more highly trained.

"you were all flopped out on the sofa with a petechial (spell it correctly please!) rash and sweats. What caused the petechial rash? The call handlers aren't mind readers, nor are the nurses able to see down the phone lines. Why didn't you get the said antihistimines?

Nee Naw

Nee Naw was a blog about life in the London Ambulance Service control room. It was written by Suzi Brent from 2005 to 2010. The blog is no longer being updated, but the archives will remain here.